Mindfulness Meditation and Anxiety Disorders

Research evaluates the effects of meditation training on patients’ biological reaction to stress

Characterized by persistent and excessive worry, generalized anxiety disorder affects nearly seven million adults in the U.S

Those who are prone to anxiety tend to have greater difficulty managing and coping with stress, experts say, where chronic stress is shown to have physiologic effects including raising heart rate and blood pressure and increasing one's risk for heart attack and stroke. In an effort to find calm, research shows those struggling with anxiety may be well-served by turning to mindfulness meditation – a technique that involves focusing on the present and non-judgmentally paying attention to thoughts and feelings as they arise.

“If you think of anxiety – there are anxious thoughts and there are anxious feelings, and those go together,” says Judson Brewer, director of research for the Center for Mindfulness at the University of Massachusetts Medical School. “There are two ways that we can deal with them.”

One is our natural learned response that since anxiety feels bad, he says, we need to do something to make it feel better. “So we avoid it, we suppress it, we repress it – we do all these things to distract ourselves from the anxiety itself.” However, attempts to avoid uncomfortable thoughts and feelings may worsen anxiety. “The paradox here is that mindfulness helps us turn toward those and learn to change our relationship to the actual thoughts and the physical sensations, rather than try to change them in any way,” Brewer says. “By changing that relationship, we actually stop feeding those cyclical processes and they start to die off on their own.” By learning mindfulness-based stress reduction – an approach first developed at UMass that uses meditation to lower stress levels – research finds many people report reduced anxiety and stress levels.



Taking that a step further, a recent National Institutes of Health-funded study published in January in the journal Psychiatry Research also looked at the biological responses of patients with generalized anxiety disorder to stress, after they’d undergone MBSR. In the study, 70 participants were randomly assigned either to receive the mindfulness meditation training or to undergo stress management education – the study’s control group. “This was a sort of a wellness class where there was a series of lectures on different topics, like sleep improvement and exercise and nutrition,” says Dr. Elizabeth Hoge, an associate professor of psychiatry at Georgetown University Medical Center in Washington. Hoge conducted the research while she was a postdoctoral researcher at Massachusetts General Hospital.

Participants were asked to give an impromptu speech in front of an audience of testers – a typically stress-inducing experience – before and after the 8-week intervention, either the mindfulness meditation training or the stress management class. They were also asked to do mental arithmetic: “Start with the number 996 and subtract by seven all the way down to zero, which is really hard to do in front of an audience,” Hoge notes. “The testers had all the numbers in front of them on a clipboard and they were wearing white lab coats, and we videotaped and had microphones and photography flood lamps. [We] basically set up the laboratory stress test to be like the worst kind of speech challenge that a person can experience.”

Even so, blood testing revealed that study participants had significantly lower levels of the stress hormone ACTH and inflammatory reactions to stress (measured by looking at inflammatory proteins IL-6 and TNF-α) following mindfulness meditation training. That compared to the control group for whom biological stress responses actually increased somewhat the second time they underwent the social stress test.



The results offer biological data showing how mindfulness meditation training can affect the ability of a person with generalized anxiety disorder to be resilient in the face of stressful circumstances. “You can’t fake that,” Hoge says; nor could the results be explained by the placebo effect or a patient’s expectation that meditation would help, since their reactions were measured at a physiological level. “For people who have generalized anxiety disorder, our research provides evidence that this might be a reasonable treatment option,” she says.

Hoge says one of the reasons she was interested in pursuing the research was to look at alternatives to standard treatments for anxiety disorders, typically antidepressant medication and psychotherapy. “It’s hard for some people to get those treatments, either because of insurance, financial limitations and also the stigma that’s involved with coming to a psychiatric clinic for treatment," she says. "And a lot of people don’t want to go on medications.”

Though standard treatments work well for many patients, experts say it’s important to provide various options to match individual preference.

One question that remains is whether the stress levels – measured on a biological level – would be reduced over the long term by meditative techniques, says Dr. Madhav Goyal, an internist at NorthBay Healthcare in Vacaville, California, and an assistant professor of general internal medicine at Johns Hopkins University School of Medicine in Baltimore. Goyal has done research on meditation programs to address stress and improve well-being. “We know that people who are more stressed in general tend to be more susceptible to getting infections” among other health issues, Goyal says.



If meditation can treat anxiety disorder and help those with anxiety better cope with stress, it could also improve a person’s overall health in the long term. But more research is needed to determine the impact that meditation might have on chronic stress levels, Goyal says.

In the immediate term, for individuals considering meditation to treat anxiety disorder, Brewer suggests MBSR, which has been well-studied in this regard. The Center for Mindfulness has a worldwide online directory of MBSR teachers certified by the UMass Center for
Mindfulness.

Ultimately, experts say, meditation may help those with anxiety gain a greater understanding of more troubling underlying emotions, such as sadness or anger, while improving their ability to cope with stress. “Instead of being drawn into these long worry bouts, people can have more freedom to deal with those thoughts in a way that’s more constructive,” Hoge says.
Writer: Michael O. Schroeder / Health.news.com

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The Possible Cause of Flashbacks Discovered

Traumatic events can stop the brain storing the context in which they took place.

Remembering the past is an important function and defines who we are. In some situations though, the normal processes that store our experiences into memory can go wrong. After experiencing a distressing event, people can develop memory disturbances where they re-experience the event in the form of flashbacks – distressing vivid images that involuntarily enter consciousness, as happens in post-traumatic stress disorder.

Our latest study shows that a distressing experience has opposite effects in two different parts of the brain: the amygdala and the hippocampus. The amygdala, a region of the brain involved in emotion, seemed to strongly encode the negative content of an experience while the hippocampus, which is involved in storing new memories, is only weakly activated.

When remembering something from the past, we can bring to mind what we were doing, the people we were with, and where the event took place. An important aspect of memory is that these separate pieces of information are bound together as a single memory so that all of it can easily be recalled at a later time. But when experiencing a distressing event, the normal processes that help to integrate this information in memory can be disrupted.

The hippocampus is crucial for forming these associations so that all parts of a memory can be later retrieved as a single event (and damage to this brain region can stop a person from forming new memories). In contrast, the amygdala is involved in processing emotional information and making basic responses to things associated with fear, such as recoiling from a snake or spider.


The hippocampus. The brain region involved in consolidating new memories.

People who have suffered a trauma often have difficulty remembering the context of the event. We thought that, while processing in the amygdala might be increased during a negative experience, processing in the hippocampus might be decreased, disrupting the way it binds the different aspects of the experience together as a single memory.

To test this idea we showed 20 volunteers pairs of pictures and asked them to remember the pictures while lying in an MRI scanner. Some of the pictures were of traumatic
scenes, such as a badly injured person.

The volunteers’ memory of the pictures was then tested in two ways. First, they were shown one picture from each pair and asked if they recognized previously seeing it. Second, if the picture was recognized, we then asked whether they could remember what other picture had been part of the original pair.

When asked whether they recognized the individual pictures, people showed better memory for previously seen pictures that were negative (traumatic) compared with pictures that were neutral, such as a person sitting at an office desk. Improved memory for negative pictures related to increased activity in the amygdala. In contrast, their memory for remembering what pictures were presented together as a pair was worse when one of the pictures was negative.



We also found that activity in the hippocampus was reduced by the presence of negative pictures suggesting that its function in storing the associations between the pictures was impaired. This imbalance could lead to strong memories for the negative content of an event that is not properly stored with the other parts of the event and the context in which it took place.

Implications for psychotherapy
This work supports the view that experiencing a traumatic event might alter how memory works. The re-experiencing of intrusive images in post-traumatic stress disorder might happen because of strengthened memory for the negative aspects of a trauma but not their context – that is, the location where the event occurred or the time it occurred. This may result in the person involuntarily retrieving the traumatic event “out of context” and experiencing it as though it was in the present.

In this case, therapy should focus on strengthening or recreating appropriate contextual associations for the negative event. This view is supported by current psychotherapies where a person is taken back to the place where the traumatic event took place to help in strengthening memory for the context.

These findings also highlight potential issues with eyewitness testimony as trauma sufferers with poorly contextualized memories are likely to provide a fragmented report of an event.

The author of this James Bisby, Research Associate, University College London. This article was originally published in The Conversation under a Creative Commons Attribution

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